DOCSLIB.ORG

Diaphragmatic Hernia Handout.Indd

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diaphragmatic Hernia Handout.Indd Diaphragmatic Hernia A diaphragmatic hernia is a birth defect, which means it occurs before birth as a fetus is forming in the mother’s uterus. The diaphragm has an abnormal opening, and with this type of birth defect, some of the organs that are normally found in the abdomen move up into the chest cavity through this opening. There are two types of diaphragmatic hernia: • Bochdalek hernia. A Bochdalek hernia usually involves an opening on the left side of the dia- phragm. The stomach, liver, spleen and/or intestines usually move up into the chest cavity. • Morgagni hernia. A Morgagni hernia involves an opening in the middle of the diaphragm close to the front of the chest. What causes a diaphragmatic hernia? As a fetus is growing in its mother’s uterus before birth, different organ systems are developing and maturing. The diaphragm develops between the seventh and twelfth weeks of pregnancy. The esophagus (the tube that leads from the throat to the stomach), the stomach and the intestines are also developing at this time. In a Bochdalek hernia, the diaphragm may not develop properly, or the intestine may become trapped in the chest cavity as the diaphragm is forming. In a Morgagni hernia, the tendon that should develop in the middle of the diaphragm does not develop properly. In both cases, normal development of the diaphragm and the digestive tract does not occur. Left-sided Bochdalek hernias make up about 80 to 90 percent of all cases. Morgagni hernias are much less common. Why is a diaphragmatic hernia of concern? The lungs are developing at the same time as the diaphragm and the digestive system. A diaphrag- matic hernia allows abdominal organs to move into the chest cavity, instead of remaining in the abdomen as they are developing. With the heart, lungs and abdominal organs all taking up space in the chest cavity, the lungs do not have space to develop properly. A diaphragmatic hernia is a life-threatening illness. When the lungs do not develop properly during pregnancy, it can be diffi cult for the baby to breathe after birth. The intestines also may not develop properly, especially if they are not receiving enough blood sup- ply while they are developing. A good blood supply is necessary for the intestines to develop cor- rectly, and to be healthy and function properly. What are the symptoms of a diaphragmatic hernia? The symptoms of a Bochdalek diaphragmatic hernia are often observable soon after the baby is born. The following are the most common symptoms of a Bochdalek diaphragmatic hernia. However, each child may experience symptoms differently. Symptoms may include: • Diffi culty breathing • Fast breathing • Fast heart rate • Cyanosis (blue color of the skin) • Abnormal chest development, with one side being larger than the other • Abdomen that appears caved in (concave) A baby born with a Morgagni hernia may or may not show any symptoms. How is a diaphragmatic hernia diagnosed? Diaphragmatic hernia can often be detected on fetal ultrasound in the second and third trimesters of pregnancy. A fetal echocardiogram (ultrasound of the heart) may also be done to check for heart abnormalities before the baby is born. If your baby has been diagnosed with a diaphragmatic hernia, we would be happy to schedule a consultation with your family and one of our top surgeons, as well as a CHOC neonatologist and your perinatologist, to prepare for the birth and subsequent care of your baby. After birth, your baby’s doctor will perform a physical examination. A chest X-ray is done to look at the abnormalities of the lungs, diaphragm and intestine. A blood test known as an arterial blood gas is often performed to evaluate the baby’s breathing ability. Other tests that may be performed include: • Blood test for chromosomes (to determine if there is a genetic problem) • Ultrasound of the heart (echocardiogram) What is the treatment for a diaphragmatic hernia? Treatment may include: • Neonatal intensive care. A diaphragmatic hernia is a life-threatening illness and requires care in a neonatal intensive care unit (NICU). Babies with diaphragmatic hernias are often unable to breathe effectively on their own because their lungs are underdeveloped. Most babies will need to be placed on a breathing machine called a mechanical ventilator to help their breathing. CHOC Children’s NICU is designated a Level 4 NICU—the highest level available because of the complex conditions we treat. • ECMO (extracorporeal membrane oxygenation). Some infants may need to be placed on a tem- porary heart/lung bypass machine called ECMO if they have severe problems. ECMO does the job that the heart and lungs would be doing – putting oxygen in the bloodstream and pumping blood to the body. ECMO may be used temporarily while a baby’s condition stabilizes and improves. CHOC is the only hospital in Orange County to offer ECMO. • Surgery. When the baby’s condition has improved, the diaphragmatic hernia will be repaired with an operation. The stomach, intestine and other abdominal organs are moved from the chest cavity back to the abdominal cavity. The hole in the diaphragm is repaired. Many babies will need to remain in the NICU for a while after surgery. Although the abdominal organs are now in the right place, the lungs still remain underdeveloped. The baby will usually need to have breathing support for a period of time after the operation. Once the baby no longer needs help from a breathing machine (ventilator), he or she may still need oxygen and medications to help with breathing for weeks, months or years. Can there be problems in the future? Babies born with diaphragmatic hernias can have long-term problems and often need regular fol- low-up after going home from the hospital. Many babies will have chronic lung disease and may require oxygen or medications to help their breathing for weeks, months or years. Many babies will have gastroesophageal refl ux. Acid and fl uids from the stomach move up into the esophagus (the tube that leads from the throat to the stomach), and can cause heartburn, vom- iting, feeding problems or lung problems. Gastroesophageal refl ux can often be controlled with medications prescribed by your child’s doctor. Some babies will have diffi culty growing. This is known as failure to thrive. The children with the most serious lung problems are most likely to have growing problems. Because of their illness, they often require more calories than a normal baby in order to grow and get healthier. Gastroesopha- geal refl ux can also cause feeding problems, preventing a baby from eating enough to grow. Some babies can have developmental problems. They may not roll over, sit, crawl, stand or walk at the same time healthy babies do. Physical therapy, speech therapy and occupational therapy are often helpful for these babies to gain muscle strength and coordination. Some babies may have some degree of hearing loss. A hearing test should be performed prior to discharge from the hospital. To schedule a consultation with a CHOC Children’s pediatric surgeon, please call 714-364-4050. Photo provided by Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities..
Load more

Recommended publications
  • Congenital Diaphragmatic Hernia
    orphananesthesia Anaesthesia recommendations for patients suffering from Congenital diaphragmatic hernia Disease name: Congenital Diaphragmatic Hernia (CDH) ICD 10: Q 79.0 Synonyms: CDH (congenital diaphragmatic hernia) In congenital diaphragmatic hernia (CDH) the diaphragm does not develop properly so that abdominal organs herniate into the thoracic cavity. This malformation is associated with lung hypoplasia of varying degrees and pulmonary hypertension. These are the main reasons for mortality. CDH can also be associated with other congenital anomalies (e.g. cardiac, urologic, gastrointestinal, neurologic) or with different syndromes (Trisomy 13, 18, Fryns- Syndrome, Cornelia-di-Lange-Syndrome, Wiedemann-Beckwith-syndrome and others). This malformation may be detected by prenatal ultrasound or MRI-investigation. There are several parameters which correlate prenatal findings with postnatal survival, need for ECMO-therapy, need for diaphragmatic reconstruction with a patch and the development of chronic lung disease. These findings include; observed-to-expected lung-to-head-ratio on prenatal ultrasound, relative fetal lung volume on MRI and intrathoracic position of liver and / or stomach in left-sided CDH. Depending on disease-severity, treatment can be challenging for neonatologists, paediatric surgeons and anaesthesiologists as well. Medicine in progress Perhaps new knowledge Every patient is unique Perhaps the diagnostic is wrong Find more information on the disease, its centres of reference and patient organisations on Orphanet: www.orpha.net 1 Typical surgery According to the CDH-EURO-Consortium there is a consensus on surgical repair of diaphragmatic hernia after sufficient stabilization of the neonate (delayed surgery). The definition of stability, determining readiness for surgery, depends on several parameters that have been proposed (see below).
    [Show full text]
  • Morgagni Hernia Associated with Hiatus Hernia, a Rare Case Hernia De Morgagni Em Associação Com Hernia Do Hiato, Um Caso Raro
    ACTA RADIOLÓGICA PORTUGUESA Janeiro-Abril 2016 nº 107 Volume XXVIII 27-29 Caso Clínico / Radiological Case Report MORGAGNI HERNIA ASSOCIATED WITH HIATUS HERNIA, A RARE CASE HERNIA DE MORGAGNI EM ASSOCIAÇÃO COM HERNIA DO HIATO, UM CASO RARO Joana Ruivo Rodrigues, Bernardete Rodrigues, Nuno Ribeiro, Carla Filipa Ribeiro, Ângela Figueiredo, Alexandre Mota, Daniel Cardoso, Pedro Azevedo, Duarte Silva Serviço de Radiologia do Centro Hospitalar Abstract Resumo Tondela-Viseu, Viseu Diretor: Dr. Duarte Silva The simultaneous occurrence of two separate A ocorrência simultânea de duas hérnias non-traumatic diaphragmatic hernias is diafragmáticas não traumáticas é extremamente extremely rare. We report a case of an old man rara. É relatado um caso de um idoso com duas Correspondência with two diaphragmatic hernias (Morgagni and hérnias diafragmáticas (hérnia de Morgagni Hiatal hernias) and we also review the clinical e do Hiato) e também revemos os aspetos Joana Ruivo Rodrigues and imagiologic features (Radiographic and clínicos e imagiológicos (Raio-X e Tomografia Rua Dr. Francisco Patrício Lote 2 Fração A Computed Tomography) of Morgagni and hiatal Computadorizada) da hérnia de Morgagni e da 6300-691 Guarda herniation. hérnia do hiato. e-mail: [email protected] Key-words Palavras-chave Recebido a 05/06/2015 Morgagni hernia; Hiatal hernia; diaphragmatic Hérnia de Morgagni; Hérnia do hiato; Hérnia Aceite a 24/11/2015 congenital hernia; chest Radiography; Computed congénita diafragmática; Radiografia torácica; Tomography. Tomografia Computorizada. Introduction intermittent, postprandial and substernal pain. The pain was not related to any type of food and was partially relieved There are only five cases of combined Morgagni and by proton pump inhibitor.
    [Show full text]
  • Right-Sided Giant Bochdalek Hernia in an Adult: a Case Report Saana Andersson*, Juha Kauppi and Jari Räsänen
    SURGICAL CASE REPORTS | ISSN 2613-5965 Available online at www.sciencerepository.org Science Repository Case Report Right-sided Giant Bochdalek hernia in an adult: a case report Saana Andersson*, Juha Kauppi and Jari Räsänen Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland A R T I C L E I N F O A B S T R A C T Article history: Diagnosis of a Bochdalek hernia in an adult is rare and even more so in the right diaphragm. Received: 29 April, 2019 We review a case of a 55-year-old woman with a right-sided giant Bochdalek hernia who was experiencing Accepted: 11 June, 2019 progressive shortness of breath and performance decline. The diagnosis of Bochdalek hernia was made by Published: 30 August, 2019 computed tomography and the right side of liver, right kidney, omentum and flexura hepatica of the colon Keywords: were herniated to the right hemithorax. The operation was carried out via right thoraco-laparotomy and she Adult made an uneventful recovery. We conclude that maximal exposure was necessary for safe operation and bochdalek good outcome. right sided © 2019 Saana Andersson Hosting by Science Repository. All rights reserved. Introduction thorax (Figure 1). Our patient underwent an elective operation and initially thoracotomy was performed. The right lobe of liver, flexura Bochdalek hernia is a diaphragmatic hernia usually diagnosed during the hepatica of the colon, omentum and right kidney were herniated into the neonatal period. It typically occurs in the left hemi-diaphragm and right hemithorax. The diaphragm was missing posteriorly and laterally, presents with severe respiratory and circulatory compromise.
    [Show full text]
  • Symptomatic Morgagni Hernia Misdiagnosed As Chilaiditi Syndrome
    Case RepoRt Symptomatic Morgagni Hernia Misdiagnosed As Chilaiditi Syndrome Phyllis A. Vallee, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, MI Supervising Section Editor: Sean Henderson, MD Submission history: Submitted October 5 2010; Revision received October 21 2010; Accepted October 27 2010 Reprints available through open access at http://scholarship.org/uc/uciem_westjem Chilaiditi syndrome, symptomatic interposition of bowel beneath the right hemidiaphragm, is uncommon and usually managed without surgery. Morgagni hernia is an uncommon diaphragmatic hernia that generally requires surgery. In this case a patient with a longstanding diagnosis of bowel interposition (Chilaiditi sign) presented with presumed Chilaiditi syndrome. Abdominal computed tomography was performed and revealed no bowel interposition; instead, a Morgagni hernia was found and surgically repaired. Review of the literature did not reveal similar misdiagnosis or recommendations for advanced imaging in patients with Chilaiditi sign or syndrome to confirm the diagnosis or rule out other potential diagnoses. [West J Emerg Med. 2011;12(1):121-123.] INTRODUCTION sounds, tenderness with guarding in the epigastric and Presence of intestinal loops cephalad to the liver is an periumbilical regions and no rebound. Stool was guaiac uncommon radiographic finding. If this bowel is located above negative. the diaphragm, an intrathoracic hernia is present. If located Shortly after examination, the patient developed beneath the diaphragm, bowel interposition or Chilaiditi sign nonbilious vomiting. She received intravenous fluid, is present. When symptoms develop in these conditions, they hydromorphone for pain and ondansetron for vomiting. Initial may have similar presentations; however, management is diagnostic evaluation showed normal complete blood count, often very different.
    [Show full text]
  • Congenital Diaphragmatic Hernia 1
    CONGENITAL DIAPHRAGMATIC HERNIA 1 Kathy Wilson, RN BSN BA RNA CDIS 03/2019 Presentation on the Following Aspects of CDH Definition of Congenital Diaphragmatic Hernia [CDH] Clinical Presentation of CDH Surgical Repair of CDH Lifelong Sequelae of CDH CDI Considerations for CDH 2 What Is A Congenital Diaphragmatic Hernia? (CDH) A congenital diaphragmatic hernia (CDH) occurs when the diaphragm muscle — the muscle that separates the chest from the abdomen — fails to close during prenatal development, and the contents from the abdomen (stomach, intestines and/or liver) migrate into the chest through this hole. 3 KW1 KW2 4 Slide 4 KW1 This picture is from CHOP website. The actual herniated diaphragm in represented in the Left picutre. The normal diaphragm is represented on he Right. Kathy Wilson, 1/30/2019 KW2 Kathy Wilson, 1/30/2019 TYPES of CDH CDH can occur on the left side, right side or, very rarely, on both sides and vary in severity A Bochdalek hernia is a hole in the back of the diaphragm. Ninety percent of Congenital Diaphragmatic Hernias are this type A Morgagni hernia involves a hole in the front of the diaphragm Very large or incomplete diaphragmatic hernias often require ECMO immediately after delivery 5 Fetal Surgical Repair of CDH [For severe cases of CDH] Fetoscopic endoluminal tracheal occlusion (FETO) is a fetal surgery procedure that may improve outcomes in babies with the most severe cases of CDH. It is performed while infant is still in utero. 6 Postnatal Surgical Repair for Small CDH Defects An incision is made just below the baby’s rib cage, the organs in the chest are guided back down into the abdomen and the hole in the diaphragm is sewn closed.
    [Show full text]
  • Chilaiditi's Sign and the Acute Abdomen
    ACS Case Reviews in Surgery Vol. 3, No. 2 Chilaiditi’s Sign and the Acute Abdomen AUTHORS: CORRESPONDENCE AUTHOR: AUTHOR AFFILIATION: Devecki K; Raygor D; Awad ZT; Puri R Ruchir Puri, MD, MS, FACS University of Florida College of Medicine, University of Florida College of Medicine Department of Surgery, Department of General Surgery Jacksonville, FL 32209 653 W. 8th Street Jacksonville, FL 32209 Phone: (904) 244-5502 E-mail: [email protected] Background Chilaiditi’s sign is a rare radiologic sign where the colon or small intestine is interposed between the liver and the diaphragm. Chilaiditi’s sign can be mistaken for pneumoperitoneum and can be alarming in the setting of an acute abdomen. Summary We present two cases of Chilaiditi’s sign resulting from vastly different pathologies. The first patient was a 67-year-old male who presented with right upper quadrant pain. He was found to have Chilaiditi’s sign on the upright chest X ray. A CT scan revealed a cecal bascule interposed between the liver and diaphragm with concomitant acute appendicitis. Diagnostic laparoscopy confirmed imaging findings, and he underwent an open right hemicolectomy. The second patient was a 59-year-old female who presented with acute onset of right-sided abdominal pain. An upright chest X ray revealed air under the right hemidiaphragm, and the CT scan demonstrated a large, right-sided Morgagni-type diaphragmatic hernia. She underwent an elective laparoscopic hernia repair, which confirmed the presence of an anteromedial diaphragmatic hernia containing small bowel, colon, and omentum. Conclusion Chilaiditi’s sign can be associated with an acute abdomen.
    [Show full text]
  • Herniation of the Liver: an Extremely Rare Entity Fatih Tekin, Aysenur Arslan and Fulya Gunsar
    CASE REPORT Herniation of the Liver: An Extremely Rare Entity Fatih Tekin, Aysenur Arslan and Fulya Gunsar ABSTRACT We hereby present the case of a 75 years old female who was complaining of right upper quadrant abdominal pain. She had a history of cystectomy, cholecystectomy and choledochotomy operations for liver hydatid cyst 5 years ago. In addition, multiple endoscopic retrograde cholangiopancreatography sessions had been performed for recurrent biliary duct stones in the last 4 years. Radiological investigations revealed the presence of cirrhosis and the herniation of the left liver lobe through the abdominal incisional hernia defect. Secondary sclerosing cholangitis as a result of the previous operations was suggested to be the probable etiology for cirrhosis. The cirrhotic patient with an advanced age was found to be high risk for surgery. In addition, her symptoms were minimal. Thus, she was managed conservatively. Herniation of the liver is very rare. It is quite difficult to speculate any predisposing risk factors for liver herniation because of the rarity of this condition. Key Words: Herniation. Incisional hernia. Liver. INTRODUCTION Physical examination revealed minimal right upper Herniation of the liver is a rare phenomenon. Most of the quadrant tenderness on palpation and minimal case reports have been associated with congenital abdominal distension. She had an incision scar at diaphragmatic hernias or diaphragmatic hernias that epigastrium with an incisional epigastric hernia including develop after a chest trauma.1,2 There have been only a rough mass which was non-tender. Laboratory tests three previous cases where the liver has herniated revealed an alkaline phosphatase of 459 U/L (normal: through the anterior abdominal wall after an abdominal 35 - 104), gamma-glutamyl transferase of 401 U/L surgery.
    [Show full text]
  • Bochdalek Hernia
    Medical Image of the Week: Bochdalek Hernia Figure 1. PA (A) and lateral (B) chest radiograph demonstrating a lobulated homogenous opacity in the posterior left lung base-blue arrows. Figure 2. Chest CT (axial image) demonstrating fat-containing opacity consistent with a Bochdalek hernia- red arrow. A 61 year-old man presented for an evaluation of a nonproductive cough. He has a history of well-controlled asthma, allergic rhinitis and nasal polyposis, hypertension, gastro-esophageal reflux and obstructive sleep apnea. The ACE inhibitor used to treat hypertension was discontinued. The physical exam was unremarkable. Pulmonary function testing was normal. Southwest Journal of Pulmonary and Critical Care/2016/Volume 12 203 A PA and lateral chest radiograph was performed and revealed an abnormal contour of the left hemidiaphragm with a large lobulated opacity (Figure 1- blue arrows). Computed chest tomography revealed the lobulated opacity in the left lower lobe contained fat and was consistent with a Bochdalek hernia (Figure 2). Congenital diaphragmatic hernia is a major malformation in newborns and in the perinatal period. The diagnosis of congenital diaphragmatic hernia in adults is rare. There are three types of congenital diaphragmatic hernias: posterolateral (Bochdalek) diaphragmatic hernia, subcostosternal (Morgagni) hernia and esophageal hiatal hernia. The Bochdalek diaphragmatic hernia is the result of a congenital diaphragmatic defect in the posterior costal part of the diaphragm in the region of 10th and 11th ribs, which allows free communication between the thoracic and abdominal cavity. The defect is usually found at the left side (90%) but may occur on the right side, where the liver often prevents detection.
    [Show full text]
  • Appendix 3.1 Birth Defects Descriptions for NBDPN Core, Recommended, and Extended Conditions Updated March 2017
    Appendix 3.1 Birth Defects Descriptions for NBDPN Core, Recommended, and Extended Conditions Updated March 2017 Participating members of the Birth Defects Definitions Group: Lorenzo Botto (UT) John Carey (UT) Cynthia Cassell (CDC) Tiffany Colarusso (CDC) Janet Cragan (CDC) Marcia Feldkamp (UT) Jamie Frias (CDC) Angela Lin (MA) Cara Mai (CDC) Richard Olney (CDC) Carol Stanton (CO) Csaba Siffel (GA) Table of Contents LIST OF BIRTH DEFECTS ................................................................................................................................................. I DETAILED DESCRIPTIONS OF BIRTH DEFECTS ...................................................................................................... 1 FORMAT FOR BIRTH DEFECT DESCRIPTIONS ................................................................................................................................. 1 CENTRAL NERVOUS SYSTEM ....................................................................................................................................... 2 ANENCEPHALY ........................................................................................................................................................................ 2 ENCEPHALOCELE ..................................................................................................................................................................... 3 HOLOPROSENCEPHALY.............................................................................................................................................................
    [Show full text]
  • Congenital Defects of the Anterior Abdominal Wall and Diaphragm
    Bulletin of the Transilvania University of Braşov Series VI: Medical Sciences • Vol. 10 (59) No. 2 - 2017 CONGENITAL DEFECTS OF THE ANTERIOR ABDOMINAL WALL AND DIAPHRAGM C.A. ARVĂTESCU1 O.G. DIMIENESCU1* S. CASAP1 1 1 1 C. PODAŞCĂ C. COBELSCHI A. MIRONESCU Abstract: Congenital defects of the anterior abdominal wall and diaphragm are malformations occurring during embryogenesis and include gastroschisis, omphalocele and diaphragmatic hernia. Diaphragmatic hernia is often accompanied by pulmonary hypoplasia that causes fetal asphyxia with varying degrees of severity. The purpose of this study was to evaluate the prevalence of congenital malformations of the anterior abdominal wall and diaphragm in the Clinical Hospital of Obstetrics and Gynecology Brasov between the years 2011 and 2017. The 29 cases included in the study range in severity from minor malformations, easily corrected through surgical procedures to severe malformations associated with other congenital anomalies that are incompatible with life. The most common congenital defect encountered in our study is diaphragmatic hernia, which can be diagnosed through correct follow up of the pregnancy, monthly ultrasounds and screening tests. Key words: omphalocele, gastroschisis, diaphragmatic hernia, abdominal wall defect. 1. Introduction but the commonest form of congenital diaphragmatic hernia is the classic Congenital defects of the anterior posterolateral or Bochdalek hernia [5]. abdominal wall and diaphragm are Omphalocele is a large defect of the malformations occurring during abdominal wall, in which the viscera embryogenesis. Omphalocele and coming out of the abdomen always has a gastroschisis are the most frequent defects sac and occurs because the rectus muscles of the anterior abdominal wall, with a are inserted laterally on the costal margins.
    [Show full text]
  • An Elderly Patient with Bochdalek's Hernia Case That Implies Left-Sided
    Case Report Eur J Gen Med 2012;9(1):64-66 An Elderly Patient with Bochdalek’s Hernia Case that Implies Left-Sided Intratoracic Renal Ectopia Hakan Önder1, Şükran Güler1, Güven Tekbaş1, Ayla Büyükkaya2, Hatice Gümüş1, Faysal Ekici1, Akın Önder3, Aslan Bilici1 ABSTRACT Bochdalek hernia is a congenital disease characterized by protrusion of the abdominal organs into the thorax through the poste- rior defect in the diaphragma. The detection of incidental bochdalek hernia has increased because of the widespread use of the multidedector computed tomography. It is very rare in adult population. Intrathoracic kidney in bochdalek hernia is uncommon. In this paper, a 78 year-old man who had bochdalek hernia with a kidney in the left side of the thoracic region is presented. Key words: Bochdalek hernia , intrathoracic kidney , diaphragmatic hernia Yaşlı Bir Hastada İntratorasik Ektopik Böbrek İle Seyreden Bochdalek Hernisi ÖZET Bochdalek hernisi posterior diafragmadan abdominal organların toraks içerisine yer değiştirmesi ile karakterize konjenital bir hastalıktır.Bochdalek hernisinin insidental olarak tesbiti çok kesitli bilgisayarlı tomografinin(ÇKBT) yaygın kullanılmasıyla artmıştır.Bochdalek hernisi yaşlı kişilerde oldukça nadir görülmektedir. Herni içerisinde böbrek görülmesi de yaygın değildir.Bu yazıda toraksda solda, içerisinde sol böbrek ve kalın barsak ansları bulunan 78 yaşında bir olgu sunulmuştur. Anahtar kelimeler: Bochdalek hernisi, İntratorasik böbrek, diyafragma hernisi INTRODUCTION CASE A Bochdalek hernia occurs when abdominal contents A 78 year-old man referred to our clinics for ultraso- herniated through the posterolateral segment of the dia- nographic examination complaints of abdominal pain phragm (1). Bochdalek hernia is a type of congenital dia- and shortness of breath. The ultrasound examination phragmatic hernia that typically occurs in childhood, but revealed that left kidney was not in its usual location.
    [Show full text]
  • Giant Hiatal Hernias
    PRACA CASEORYGINALNA REPORT Jan Lesinski1, Tadeusz M. Zielonka1, 2, Olga Wajtryt1, Krystyna Peplinska3, Aleksandra Kaszynska3 1Clinical Department of Internal Medicine, Czerniakowski Hospital in Warsaw, Poland 2Departement of Family Medicine, Warsaw Medical University, Warsaw, Poland 3Department of Internal Medicine and Cardiology, Solec Hospital in Warsaw, Poland Giant hiatal hernias The authors declare no financial disclosure Abstract Dyspnoea is most often caused by disorders of the respiratory and/or cardiovascular systems. Much less often it is brought about by the displacement of abdominal organs into the thoracic cage. Hiatal hernias may give rise to diagnostic difficulties, as both clinical and radiological symptoms suggest different disorders. Computed tomography is the method of choice when making a diagnosis. We have presented a series of 7 cases of giant hiatal hernias, each with a varying course of the disease, clinical symptoms, radiological features and prognoses. In two of the cases, the hernias were of a post-traumatic nature. Four cases of large diaphragmatic hernias were found in elderly patients (over 90 years old). An advanced age and numerous coexisting chronic diseases disqualified most of the patients from surgical treatment despite the hernias’ large sizes. In only one case was fundoplication performed with a good end result. Two patients died, and an extensive hernia was the cause of one of the deaths. Upper gastrointestinal symptoms were present only in a few of the patients. An early diagnosis of giant hiatal hernia is crucial for the patients to undergo prompt corrective surgeries. Key words: acquired diaphragmatic hernia, dyspnoea, elderly patients, gastroesophageal reflux disease, kyphoscoliosis, hiatal hernia Adv Respir Med.
    [Show full text]